US20170319352A1 - Geared cam expandable interbody implant and method of implanting same - Google Patents
Geared cam expandable interbody implant and method of implanting same Download PDFInfo
- Publication number
- US20170319352A1 US20170319352A1 US15/147,668 US201615147668A US2017319352A1 US 20170319352 A1 US20170319352 A1 US 20170319352A1 US 201615147668 A US201615147668 A US 201615147668A US 2017319352 A1 US2017319352 A1 US 2017319352A1
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- Prior art keywords
- distal end
- yoke
- implant
- endplate
- proximal end
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- A61F2/4455—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages
- A61F2/447—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages substantially parallelepipedal, e.g. having a rectangular or trapezoidal cross-section
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- A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2250/0004—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable
- A61F2250/0009—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable for adjusting thickness
Definitions
- the present invention relates to a spinal implant, and a method for implanting the implant in a patient's disc space between two adjacent vertebral bodies. More particularly, the present invention relates to an expandable spinal implant including geared cams, configured to expand within the patient's disc space, from a collapsed position to an expanded position.
- Expandable spinal implants are known. Existing expandable spinal implants use conventional “4-bar” and “crank slider” expansion mechanisms. Following insertion, while in the collapsed position, into a surgically-enhanced disc space, the existing expandable spinal implants are expanded.
- the existing expandable implants have been known at least to (1) apply an undesirable excessive initial expansion force to the disc space, (2) apply an irregular expansion force to the disc space, (3) occasionally inadvertently back out of the disc space, and (4) lack a reliable capability for fine adjustment.
- Existing expandable implants also lack different configurations at the distal tip of the implant, which often could be advantageous, e.g., to ensure engagement between the distal tip and the adjacent vertebral bodies.
- the implant has a proximal end and a distal end defining a mid-longitudinal axis therebetween, and is expandable between a collapsed position, a partially-expanded position, and a fully-expanded position.
- the implant includes an upper endplate.
- the upper endplate has a proximal end, a distal end, an outer surface, first and second side surfaces, and an inner surface.
- a portion of the inner surface includes an upper rack portion.
- the upper rack portion includes downwardly-projecting teeth intermediate the proximal end and the distal end of the upper endplate, and at least one distal-most downwardly-projecting tooth proximate the distal end of the upper endplate.
- the implant further includes a lower endplate.
- the lower endplate has a proximal end, a distal end, an outer surface, first and second side surfaces, and an inner surface.
- a portion of the inner surface includes a lower rack portion.
- the lower rack portion includes upwardly-projecting teeth intermediate the proximal end and the distal end of the lower endplate, and at least one distal-most upwardly-projecting tooth proximate the distal end of the lower endplate.
- the proximal end of the lower endplate is pivotally connected to the proximal end of the upper endplate.
- a chassis portion is mounted within the implant between the upper endplate and the lower endplate.
- the chassis portion has a proximal end and a distal end.
- the proximal end has an opening defined therein.
- a yoke is movably mounted within the chassis portion.
- the yoke has a proximal end and a distal end.
- the yoke is defined by first and second parallel spaced-apart walls extending from the proximal end to the distal end.
- a rotating portion is rotatably mounted within the chassis portion.
- the rotating portion has a proximal end and a distal end.
- the distal end is configured to contact the distal cross-piece of the yoke.
- the proximal end has an opening defined therein, configured to receive a distal end of an implant expansion tool.
- At least one first spur gear is rotatably mounted on a distal end of one of the first and second walls of the yoke.
- the at least one first spur gear has teeth configured to engage the downwardly-projecting teeth of the upper rack portion.
- At least one second spur gear is rotatably mounted on a distal end of one of the first and second walls of the yoke.
- the at least one second spur gear has teeth configured to engage the upwardly-projecting teeth of the lower rack portion.
- the rotating portion is configured to translate rotational motion thereof to linear motion of the yoke.
- the yoke translates the linear motion to rotation of the spur gears with respect to the yoke, causing the spur gears to walk along the upper rack gear teeth and lower rack gear teeth, respectively, toward the distal end of the implant, thereby moving the implant through the partially-expanded position.
- the spur gear teeth abut against the distal-most teeth, respectively of the upper rack or the lower rack, the implant has reached the fully-expanded position.
- One or more spikes are pivotally mounted in pockets within the implant.
- the linear motion of the yoke pushes distal ends of the spikes into contact with ramped surfaces defined in openings in the upper and lower endplates.
- Contact with the ramped surfaces causes the one or more spikes to pivot to fully-deployed positions, with distal edges of the one or more spikes engaging the upper and lower vertebral bodies. This engagement between the distal edges of the one or more spikes, and the upper and lower vertebral bodies prevents the implant, in the fully-expanded position, from inadvertently backing out of the disc space.
- First and second flaps are attached to the respective first and second side surfaces of the upper endplate and the lower endplate.
- the flaps can be made of porous, semi-porous, or solid materials, depending on the application.
- the flaps When the implant is in the collapsed position, the flaps can either be stretched tight between the respective side surfaces, or hang loosely between the respective side surfaces.
- the flaps When the implant is fully expanded, the flaps are stretched tight between the respective side surfaces, functioning as a barrier to prevent bone graft material from leaking out of the sides of the fully expanded implant.
- the method includes inserting the implant into a surgically-prepared disc space, in the collapsed position, using an implant insertion tool, rotating the rotating portion, defining a rotational motion, translating the rotational motion of the rotating portion into a linear motion of the yoke toward the distal end of the implant, rotating the spur gears with respect to the yoke, thereby walking the spur gears along the projecting teeth of the respective upper and lower racks, and expanding the implant through the partially-expanded position to the fully-expanded position.
- the linear motion of the yoke also translates into pivotal motion of the one or more spikes mounted in the implant.
- the one or more spikes pivot from a collapsed position in the implant to a fully-deployed position with distal ends in engagement with upper and lower vertebral bodies adjacent the disc space.
- the insertion tool includes an outer hollow shaft, an inner hollow shaft configured to pass through the outer shaft, and an elongated driver configured to pass through the inner hollow shaft.
- the elongated driver has a blunt distal end configured to contact a portion of the implant.
- FIG. 1 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention, in a collapsed position;
- FIG. 2 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention, in a partially expanded position;
- FIG. 3 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention, in a partially expanded position;
- FIG. 4 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention, in a fully expanded position;
- FIG. 5 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention, in a fully expanded position;
- FIG. 6 is an exploded parts view of a geared cam expandable spinal implant in accordance with the invention.
- FIG. 7 is an upper perspective view of a lower endplate, chassis portion, yoke, rotating portion, and spur gears, of a geared cam expandable spinal implant in accordance with the invention
- FIG. 8 is a cross-sectional side view of a geared cam expandable spinal implant in accordance with the invention, in a collapsed position;
- FIG. 9 is a cross-sectional side view of a geared cam expandable spinal implant in accordance with the invention, in a fully-expanded position;
- FIGS. 10-16 are side schematic views of a multi-stage expansion mechanism used in one preferred embodiment of a geared cam expandable spinal implant in accordance with the invention.
- FIG. 17 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention, in a collapsed position;
- FIG. 18 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention, in a fully open position;
- FIG. 19 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention, in a partially expanded position
- FIG. 20 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention, in a fully expanded position
- FIG. 21 is a side cross-sectional view of a geared cam expandable spinal implant in accordance with the invention, in a partially expanded position;
- FIG. 22 is a side cross-sectional view of a geared cam expandable spinal implant in accordance with the invention, in a fully expanded position;
- FIG. 23 is an upper perspective view of another embodiment of a geared cam expandable spinal implant in accordance with the invention, in a collapsed position;
- FIG. 24 is an upper perspective view of the embodiment of FIG. 23 , in a fully expanded position
- FIG. 25 is an exploded parts view of a geared cam expandable implant in accordance with the invention.
- FIG. 26 is a side cross-sectional view of a geared cam expandable spinal implant in accordance with the invention, in a collapsed position;
- FIG. 27 is a side cross-sectional view of a geared cam expandable spinal implant in accordance with the invention in a fully expanded position
- FIGS. 28 and 29 are rear views of a geared cam expandable spinal implant in accordance with the invention.
- FIG. 30 is a side cross-sectional view of a geared cam expandable spinal implant in accordance with the invention in a collapsed position
- FIG. 31 is a side cross-sectional view of a geared cam expandable spinal implant in accordance with the invention in a fully expanded position
- FIGS. 32-34 are side schematic views of a spur gear and rack in a one-stage expansion mechanism
- FIG. 35 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention in a collapsed position
- FIG. 36 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention in a fully expanded position
- FIG. 37 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention in a fully expanded position
- FIG. 38 is an upper perspective cross-sectional view of an implant insertion tool in accordance with the invention connected to a geared cam expandable spinal implant in accordance with the invention;
- FIG. 39 is an upper perspective view of an implant insertion tool in accordance with the invention connected to a geared cam expandable spinal implant in accordance with the invention, depicting insertion of the implant into a disc space;
- FIG. 40 is an upper perspective cross-sectional view of an implant insertion tool in accordance with the invention connected to a geared cam expandable spinal implant in accordance with the invention;
- FIG. 41 is an upper perspective cross-sectional view of a geared cam expandable implant attached to an implant insertion tool in accordance with the invention.
- FIG. 42 is an upper perspective cross sectional view of a geared cam expandable implant in accordance with the invention being inserted into a disc space by an implant insertion tool in accordance with the invention;
- FIG. 43 is an upper perspective cross sectional view of a geared cam expandable implant in accordance with the invention being inserted into a disc space by an implant insertion tool in accordance with the invention;
- FIG. 44 is an upper perspective cross sectional view of a geared cam expandable implant inserted into the disc space, following removal of the implant insertion tool;
- FIG. 45 is an upper perspective view of a geared cam expandable implant in accordance with the invention being supported by a lower vertebral body;
- FIG. 46 is an upper perspective view depicting points of attachment between a geared cam expandable implant in accordance with the invention, and an implant insertion tool in accordance with the invention.
- FIG. 47 is a side cross-sectional view of a geared cam expandable spinal implant in accordance with the invention.
- FIG. 48 is a side cross-sectional view of a geared cam expandable spinal implant in accordance with the invention.
- FIG. 49 is a partial upper perspective view depicting a lower endplate, chassis, yoke, lower spur gear, and cylinder with circumferential ratchet teeth;
- FIG. 50 is a perspective view of a geared cam expandable implant in accordance with the invention, including deployable spikes, pivotally attached to the implant, in a fully-expanded position;
- FIG. 51 is a perspective view depicting a chassis portion, a yoke, a rotating portion, spur gears, and deployable spikes pivotally attached to the yoke, of a geared cam expandable implant in accordance with the invention
- FIG. 52 is a side view of a geared cam expandable implant in accordance with the invention, including deployable spikes, pivotally attached to the implant, in a collapsed position;
- FIG. 53 is a side view of a geared cam expandable implant in accordance with the invention, including deployable spikes, pivotally attached to the implant in a partially expanded position;
- FIG. 54 is a side view of a geared cam expandable implant in accordance with the invention, including deployable spikes, pivotally attached to the implant, in a fully expanded position;
- FIG. 55 is a side view of a geared cam expandable implant in accordance with the invention, including deployable spikes, pivotally attached to the implant, and including apertures defined through internal parts, in a fully expanded position;
- FIG. 56 is a side view of a geared cam expandable implant in accordance with the invention, in a collapsed position, including deployable spikes, pivotally attached to the implant, and including lateral openings to allow flow of bone graft material out of sides of the implant, and further including a planar portion in the upper endplate to distribute load forces, in a fully expanded position;
- FIG. 57 is a front view of a geared cam expandable implant in accordance with the invention, including flaps attached to sides of the implant, in a closed position;
- FIG. 58 is an upper view of a geared cam expandable implant in accordance with the invention, including flaps attached to sides of the implant, in a closed position;
- FIG. 59 is a side view of a geared cam expandable implant in accordance with the invention, including flaps attached to sides of the implant, in a closed position;
- FIG. 60 is a side cross-sectional view of a geared cam expandable implant in accordance with the invention, in a collapsed position, with a bone graft insertion apparatus connected to a proximal end of the implant;
- FIG. 61 is a side cross-sectional view of a geared cam expandable implant in accordance with the invention, in a fully expanded position, with a bone graft insertion apparatus connected to a proximal end of the implant;
- FIG. 62 is a side cross-sectional view of a geared cam expandable implant in accordance with the invention, in a fully expanded position, with a bone graft insertion apparatus connected to a proximal end of the implant, and a graft insertion tube filled with bone graft material provided within the bone graft insertion apparatus.
- a geared cam expandable spinal implant 10 is configured to be inserted in a surgically-enhanced disc space between an upper vertebral body and an adjacent lower vertebral body.
- the implant 10 includes a proximal end 12 and a distal end 14 , defining a mid-longitudinal axis L-L therebetween.
- the implant 10 includes an upper endplate 16 .
- the upper endplate 16 includes a proximal end 18 , a distal end 20 , side surfaces 22 , and an inner surface 24 .
- the inner surface 24 includes an upper rack portion 26 , which includes downwardly-projecting teeth 28 , and a distal-most downwardly-projecting tooth 29 .
- the implant 10 includes a lower endplate 30 .
- the lower endplate 30 includes a proximal end 32 , a distal end 34 , side surfaces 36 , and an inner surface 38 .
- the inner surface 38 includes a lower rack portion 40 , which includes upwardly-projecting teeth 42 , and a distal-most upwardly-projecting tooth 43 .
- the implant 10 includes a chassis portion 44 mounted within the implant between the upper endplate 16 and the lower endplate 30 .
- the chassis portion 44 includes a proximal end 46 and a distal end 48 .
- the proximal end 46 of the chassis portion 44 is a wall perpendicular to the mid-longitudinal axis L-L, having an opening 50 defined through the wall, and one or more depressions 52 defined in the wall proximate the opening 50 .
- the chassis portion 44 further includes a first set of internal threads 54 defined in the opening 50 of the proximal end 46 .
- the chassis portion 44 includes an arcuate portion 56 intermediate the proximal end 46 and the distal end 48 .
- a second set of internal threads 58 is defined on an inner surface of the arcuate portion 56 .
- a yoke 60 is movably mounted within the chassis portion 44 .
- the yoke 60 is defined by a first wall 62 , and a parallel second wall 64 spaced away from the first wall 62 .
- First wall 62 has a proximal end 66 and a distal end 68 .
- Second wall 64 has a proximal end 70 and a distal end 72 .
- distal ends 68 and 72 of first and second walls 62 and 64 can be connected by a distal end cross-piece 71 .
- the yoke 60 includes a slot 74 defined in at least one of first wall 62 and second wall 64 .
- Each slot 74 is configured to receive therein a pin 76 projecting from an inner side surface of the lower endplate 30 . Insertion of the pin 76 into the slot 74 assists in preventing separation of the implant 10 .
- a rotating portion 78 is rotatably mounted within the chassis portion 44 .
- Rotating portion 78 includes a proximal end 80 , a distal end 82 , and an outer surface 84 , with outer threads 86 defined on the outer surface 84 .
- the distal end 82 includes a T-shaped projection 88 .
- the invention is not limited to having a T-shaped projection at the distal end 82 of the rotating portion 78 .
- the proximal end 80 of the rotating portion includes an opening 89 , configured to receive therein a distal end of an implant expansion tool (not shown).
- the invention is not limited to any particular configuration for the opening 89 , as long as the rotating portion 78 can be rotated by the implant expansion tool.
- the opening 89 has a polygonal shape to receive a polygonal-shaped distal end of the implant expansion tool.
- the opening 89 could be threaded to receive a threaded distal end of the implant expansion tool.
- the threaded rotating portion 78 has been replaced by a cylinder 164 with circumferential ratchet teeth 166 , and the mating threads 54 on the arcuate portion 56 have been replaced by integral pawls 168 .
- the ratchet teeth 166 are separated by grooves 170 .
- the pawls 168 are allowed to flex because they are integral with “live” springs 172 attached to the chassis portion 44 . In this embodiment, as the ribbed cylinder 164 is advanced, each pawl 168 advances to the next respective groove 170 .
- a pair of first spur gears 90 is rotatably mounted to the distal end 68 of the first wall 62 of the yoke 60 , and the distal end 72 of the second wall 64 of the yoke 60 , respectively.
- Each first spur gear 90 includes projecting first spur gear teeth 92 , configured to engage with the downwardly-projecting teeth 28 of the upper rack portion 26 .
- a second spur gear 94 is rotatably mounted between the distal end 68 of the first wall 62 of the yoke 60 , and the distal end 72 of the second wall 64 of the yoke 60 , respectively.
- the spur gears 90 and 94 are rotatably attached to the yoke 60 with a pin 98 .
- the second spur gear 94 includes projecting second spur gear teeth 96 , configured to engage with the upwardly-projecting teeth 42 of the lower rack portion 40 .
- the invention is not limited to having two first spur gears 90 and one second spur gear 94 .
- the invention can include two first spur gears 90 and two second spur gears 94 . It is also within the scope of the invention to have one first spur gear 90 , and two second spur gears 94 .
- a slot 160 is defined in the side surface 36 proximate the distal end 34 of the lower endplate 30 , and a pin 162 is defined projecting from a second spur gear 94 . Pin 162 is configured to engage with slot 160 , to help prevent the upper and lower endplates from separating.
- the rotating portion 78 rotates within the chassis portion 44 , with the outer threads 86 of the rotating portion 78 engaging threaded portion 58 of the chassis portion 44 , until the distal end 82 of the rotating portion 78 contacts the distal cross-piece 71 of the yoke 60 .
- Rotation of the rotating portion 78 is translated into linear motion of the yoke 60 towards the distal end 14 of the implant 10 .
- Linear motion of the yoke 60 causes the first spur gears 90 , and the second spur gears 94 to rotate.
- the respective first spur gear teeth 92 and second spur gear teeth 96 “walk” towards the distal end 14 of the implant 10 in the respective downwardly-projecting teeth 28 of the upper rack portion 26 , and upwardly-projecting teeth 42 of the lower rack portion 40 .
- the teeth “walk” the upper endplate 16 is moved away from the lower endplate 30 , thereby moving the implant 10 into and through the partially-expanded position.
- the respective spur gear teeth 92 and 96 reach the respective distal-most downwardly-projecting tooth 29 , or alternately the distal-most upwardly-projecting tooth 43 , they can “walk” no farther towards the distal end of the implant 10 , and the implant has reached the fully-expanded position.
- the amount of expansion in the fully-expanded position is related to the length of the spur gears.
- the spur gears have a length S 1 , but different spur gear lengths are possible, depending on the requirements of an individual patient. Different amounts of full expansion, related to spur gear length are depicted, for example, in FIGS. 4, 5, 9, 20 , and 22 .
- the spur gears 90 and 94 “walk” along the respective racks 26 and 40 in a one-stage expansion movement, with the respective spur simply rolling along the respective rack.
- the spur gears 90 and 94 “walk” along the respective racks 26 and 40 in a multi-stage expansion movement, including the respective spur initially rolling along the respective rack, as depicted in FIGS. 10 and 11 , and subsequently pivoting in a ball and socket fashion, as depicted in FIGS. 12 and 13 .
- the circumferences of the pitch diameters translate along each other as the gear is advanced. This translation allows a higher angle of incidence at the starting point for the device as compared to a fixed-length link mechanism. The angle of incidence/mechanical advantage starts high and decreases as the gear is advanced, increasing as the gear advances further.
- the multi-stage expansion pattern allows a constant angle of attack of the gear with the rack.
- the upper endplate 16 includes projections 100 , configured to engage a surface of the endplate of the upper vertebral body (not shown).
- the upper endplate 16 further includes an opening 102 defined therein, configured to allow bone growth from bone growth material loaded in the implant 10 to pass through the opening 102 and fuse with the upper vertebral body.
- the upper endplate 16 further includes a smooth surface 104 , configured to distribute the vertebral body endplate loading.
- the smooth surfaces 104 can be configured along a majority of the length of the upper surface of the upper endplate 16 , as depicted in FIGS. 1 and 2 , or for only a portion of the length of the upper surface, to contact only the softer cancellous-like bone off the upper vertebral body endplate.
- the lower endplate 30 includes projections 106 for engaging the endplate of the lower vertebral body (depicted in FIG. 45 ), and an opening 108 configured to allow bone growth from the bone graft material in the implant 10 to pass through the opening 108 and fuse with the lower vertebral body.
- the distal end 20 of the upper endplate 16 , and the distal end 34 of the lower endplate 30 define a tip 110 .
- the tip 110 can be beveled, as depicted in FIG. 45 ; flat, as depicted in FIGS. 23 and 24 ; or come to a central point, as depicted in FIG. 26 .
- the tip 110 can include bone-engaging projections 112 .
- the tip 110 can have no projections.
- the bone-engaging projections 112 are configured to prevent implant migration as the implant 10 is expanding.
- the bone-engaging projections 112 may be perpendicular to the side surfaces 22 and 36 , but generally follow the shape of the tip 110 , or they could be parallel to the tip 110 .
- an engaging pin 114 extends from at least one spur gear 90 or 94 , and is engaged in a slot 116 in a side of the upper endplate 16 . Engagement of the engaging pin 114 in slot 116 assists in preventing the endplates 16 and 30 from decoupling during expansion of the implant 10 .
- an upper gear 118 is defined at the proximal end 18 of the upper endplate 16 , in engagement with a lower gear 120 defined at the proximal end 32 of the lower endplate 30 .
- an independent proximal expansion mechanism 122 is defined at the proximal end 12 of the implant 10 .
- the proximal expansion mechanism 122 includes a proximal-end polygonal-shaped toggle 124 , attached to the proximal end 80 of the rotating portion 78 .
- a pair of proximal-end pivot pins 126 projects from the proximal-end toggle 124 .
- the toggle 124 can have one distraction position while in another embodiment, the toggle 124 can have progressive distraction positions.
- the toggle 124 can be rotated, while in another embodiment, the toggle 124 can be translated. In the embodiment where the toggle 124 is rotated, the pivot pins 126 distract, using a cam-like action. In the embodiment where the toggle 124 is translated, the pivot pins 126 are distracted by sliding along proximal ramps 128 .
- an insertion tool 130 depicted in FIGS. 38-44 and 46 , includes a proximal end 132 , and a distal end 134 .
- An outer hollow cylindrical shaft 136 extends between the proximal end 132 and the distal end 134 .
- An inner hollow cylindrical shaft 138 extends through the outer shaft 136 .
- the inner shaft 138 has a proximal end 140 and a distal end 142 .
- a T-handle 158 is defined at the proximal end 140 of the inner shaft 138 .
- the T-handle 158 attaches to an elongated driver 143 , which extends through the inner shaft 138 .
- the elongated driver 143 has a blunt distal end 154 .
- a tap cap 144 is defined at the proximal end 140 of the inner shaft 138 , attached to the driver 143 .
- the tap cap 144 fits removably into a funnel 146 defined at the proximal end 140 of the inner shaft 138 .
- a handle 148 is provided, gripping an outer surface of the outer shaft 136 .
- Handle 148 is configured to be held by a surgeon while using the insertion tool 130 .
- the distal end 134 of the outer shaft 136 includes projecting fingers 150 , configured to fit into the depressions 52 , proximate the opening 50 in the proximal end 46 of the chassis portion 44 .
- the distal end 142 of the inner shaft 138 includes external threads 152 , configured to engage the first set of inner threads 54 in the opening 50 of the chassis portion 44 .
- the elongated driver 143 moves the elongated driver 143 , either by applying a force to the T-handle 158 , or by applying a force to the tap cap 144 , the elongated driver 143 is moved through the inner shaft 138 , through the opening 50 in the proximal end 46 of the chassis portion 44 , and through the chassis portion 44 , until the blunt proximal end opening 89 in the rotating portion 78 . Translation of the motion of the elongated driver 143 to the rotating portion 78 pushes the implant 10 into the disc space. Following removal of the elongated driver 143 from the implant 10 and the inner shaft 138 , as depicted in FIG. 44 , bone growth material can be inserted through the inner shaft 138 and into the implant 10 .
- upper spikes 174 and lower spikes 176 are pivotally connected to the walls 62 and 64 of the yoke 60 .
- Each upper spike 174 includes a proximal end 177 pivotally connected to a wall of the yoke, and a distal end 178 .
- Each lower spike 176 includes a proximal end 180 pivotally connected to a wall of the yoke, and a distal end 182 .
- Each distal end 178 includes an upper arcuate distal end portion 184 and an upper edge 185 .
- Each distal end 182 includes a lower arcuate distal end portion 186 and a lower distal edge 188 .
- upper pockets 190 are defined within the implant 10 to store the upper spikes 174 when the implant 10 is in the collapsed position.
- lower pockets 192 are defined within the implant 10 to store the lower spikes 176 when the implant 10 is in the collapsed position.
- an upper opening 194 is defined in the upper endplate 16 proximate the upper pocket 190 .
- a lower opening 196 is defined in the lower endplate 30 proximate the lower pocket 192 .
- the upper opening 194 includes an upper ramped surface 198 at a distal end thereof, and the lower opening 196 includes a lower ramped surface 200 at a distal end thereof.
- Torque T forces the lower spikes 176 to pivot counter-clockwise, through the lower opening 196 in the lower endplate 30 .
- the upper spikes 174 continue to pivot until they reach an orientation along an axis which is transverse to the mid-longitudinal axis L-L of the implant 10 , with the upper edges 185 engaging the upper vertebral body.
- the lower spikes 176 continue to pivot until they reach an orientation along an axis transverse to the mid-longitudinal axis L-L of the implant 10 , with the lower edges 188 engaging the lower vertebral body.
- apertures can be defined in internal parts of the implant, for example co-axial apertures 202 and transverse apertures 204 defined in the rotating portion 78 .
- the apertures 202 and 204 are configured to permit flow of bone graft material therethrough as it is injected from the proximal end 46 of the chassis 44 .
- a co-axial aperture 206 is opened in the chassis 44 behind the proximal ends 177 and 180 of the spikes 174 and 176 , respectively.
- Co-axial aperture 206 also is configured to allow a flow of bone growth material therethrough.
- flaps 208 are attached to the right and left sides of the implant 10 (only one side shown), with upper and lower edges thereof connected between the upper endplate 16 and the lower endplate 30 .
- the flaps 208 can be made of a porous material, a semi-porous material, or a solid material.
- an implant 10 includes a bone graft inserter 210 , attachable to attachment clamps 212 provided at the proximal end 46 of the chassis portion 44 .
- the bone graft inserter includes an outer tube 214 defining a lumen 216 therethrough, and a handle 218 .
- the attachment clamps 212 are positioned to firmly grip a distal end of the outer tube 214 .
- a graft tube 220 is provided within the lumen 216 .
- Bone graft material in the graft tube 220 is in position to flow into the chassis portion 44 of the implant 10 via the connection between the attachment clamps 212 and the outer tube 214 .
- the bone graft material inserted into the chassis portion 44 of the implant 10 can flow out of the implant 10 via multiple small apertures (not shown) in the upper and lower endplates 16 and 30 , respectively, and via the open distal end of the expanded implant 10 .
- a rigid plunger 222 is provided in the lumen 216 .
- the plunger 222 includes a head portion 224 at a distal end thereof.
- the head portion 224 has a diameter approximately equal to a diameter of the lumen 216 .
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Abstract
A geared cam expandable spinal implant. Rotational motion of a rotating portion is translated into linear motion of a yoke, which moves geared cams at the distal end of the implant to mate with, and walk along, teeth of corresponding racks. The walking of the gear cam teeth along the rack teeth creates a regular rate of implant expansion, reduces initial excessive expansion force applied to the implant, and provides fine adjustment of the expansion rate and force. Spikes, pivotally mounted on the yoke, pivot outward as the implant expands, to a fully-deployed position into engagement with surfaces of adjacent vertebral bodies. The engagement between the deployed spikes and the vertebral bodies prevents inadvertent backout of the expanded implant.
Description
- The present invention relates to a spinal implant, and a method for implanting the implant in a patient's disc space between two adjacent vertebral bodies. More particularly, the present invention relates to an expandable spinal implant including geared cams, configured to expand within the patient's disc space, from a collapsed position to an expanded position.
- Expandable spinal implants are known. Existing expandable spinal implants use conventional “4-bar” and “crank slider” expansion mechanisms. Following insertion, while in the collapsed position, into a surgically-enhanced disc space, the existing expandable spinal implants are expanded. The existing expandable implants have been known at least to (1) apply an undesirable excessive initial expansion force to the disc space, (2) apply an irregular expansion force to the disc space, (3) occasionally inadvertently back out of the disc space, and (4) lack a reliable capability for fine adjustment. Existing expandable implants also lack different configurations at the distal tip of the implant, which often could be advantageous, e.g., to ensure engagement between the distal tip and the adjacent vertebral bodies.
- It is an object of the present invention to provide an expandable spinal implant which obviates one or more of the shortcomings of the related art.
- It is another object of the present invention to provide an expandable spinal implant for insertion into a patient's disc space between an upper vertebral body and a lower vertebral body. The implant has a proximal end and a distal end defining a mid-longitudinal axis therebetween, and is expandable between a collapsed position, a partially-expanded position, and a fully-expanded position.
- The implant includes an upper endplate. The upper endplate has a proximal end, a distal end, an outer surface, first and second side surfaces, and an inner surface. A portion of the inner surface includes an upper rack portion. The upper rack portion includes downwardly-projecting teeth intermediate the proximal end and the distal end of the upper endplate, and at least one distal-most downwardly-projecting tooth proximate the distal end of the upper endplate. The implant further includes a lower endplate. The lower endplate has a proximal end, a distal end, an outer surface, first and second side surfaces, and an inner surface. A portion of the inner surface includes a lower rack portion. The lower rack portion includes upwardly-projecting teeth intermediate the proximal end and the distal end of the lower endplate, and at least one distal-most upwardly-projecting tooth proximate the distal end of the lower endplate. The proximal end of the lower endplate is pivotally connected to the proximal end of the upper endplate.
- A chassis portion is mounted within the implant between the upper endplate and the lower endplate. The chassis portion has a proximal end and a distal end. The proximal end has an opening defined therein.
- A yoke is movably mounted within the chassis portion. The yoke has a proximal end and a distal end. The yoke is defined by first and second parallel spaced-apart walls extending from the proximal end to the distal end. A distal cross-piece, transverse to the longitudinal axis, connects the distal ends of the first and second walls of the yoke.
- A rotating portion is rotatably mounted within the chassis portion. The rotating portion has a proximal end and a distal end. The distal end is configured to contact the distal cross-piece of the yoke. The proximal end has an opening defined therein, configured to receive a distal end of an implant expansion tool.
- At least one first spur gear is rotatably mounted on a distal end of one of the first and second walls of the yoke. The at least one first spur gear has teeth configured to engage the downwardly-projecting teeth of the upper rack portion. At least one second spur gear is rotatably mounted on a distal end of one of the first and second walls of the yoke. The at least one second spur gear has teeth configured to engage the upwardly-projecting teeth of the lower rack portion.
- The rotating portion is configured to translate rotational motion thereof to linear motion of the yoke. The yoke translates the linear motion to rotation of the spur gears with respect to the yoke, causing the spur gears to walk along the upper rack gear teeth and lower rack gear teeth, respectively, toward the distal end of the implant, thereby moving the implant through the partially-expanded position. When the spur gear teeth abut against the distal-most teeth, respectively of the upper rack or the lower rack, the implant has reached the fully-expanded position.
- One or more spikes are pivotally mounted in pockets within the implant. The linear motion of the yoke pushes distal ends of the spikes into contact with ramped surfaces defined in openings in the upper and lower endplates. Contact with the ramped surfaces causes the one or more spikes to pivot to fully-deployed positions, with distal edges of the one or more spikes engaging the upper and lower vertebral bodies. This engagement between the distal edges of the one or more spikes, and the upper and lower vertebral bodies prevents the implant, in the fully-expanded position, from inadvertently backing out of the disc space.
- First and second flaps are attached to the respective first and second side surfaces of the upper endplate and the lower endplate. The flaps can be made of porous, semi-porous, or solid materials, depending on the application. When the implant is in the collapsed position, the flaps can either be stretched tight between the respective side surfaces, or hang loosely between the respective side surfaces. When the implant is fully expanded, the flaps are stretched tight between the respective side surfaces, functioning as a barrier to prevent bone graft material from leaking out of the sides of the fully expanded implant.
- It is a further object of the present invention to provide a method of implanting the expandable spinal implant described above into a patient's disc space between an upper vertebral body and a lower vertebral body. The method includes inserting the implant into a surgically-prepared disc space, in the collapsed position, using an implant insertion tool, rotating the rotating portion, defining a rotational motion, translating the rotational motion of the rotating portion into a linear motion of the yoke toward the distal end of the implant, rotating the spur gears with respect to the yoke, thereby walking the spur gears along the projecting teeth of the respective upper and lower racks, and expanding the implant through the partially-expanded position to the fully-expanded position. The linear motion of the yoke also translates into pivotal motion of the one or more spikes mounted in the implant. The one or more spikes pivot from a collapsed position in the implant to a fully-deployed position with distal ends in engagement with upper and lower vertebral bodies adjacent the disc space. The fully-deployed spikes, in engagement with the upper and lower vertebral bodies, prevent the fully-expanded implant from backing out of the disc space. The insertion tool includes an outer hollow shaft, an inner hollow shaft configured to pass through the outer shaft, and an elongated driver configured to pass through the inner hollow shaft. The elongated driver has a blunt distal end configured to contact a portion of the implant. Application of a movement to the elongated driver is transferred to the implant, forcing the implant into the disc space. After removal of the elongated driver, bone growth material can be routed through the inner shaft and into the implant. The one or more fully-deployed spikes, in engagement with the upper and lower vertebral bodies, prevent the fully-expanded implant from inadvertently backing out of the disc space.
- These and other objects of the present invention will be apparent from review of the following specification and the accompanying drawings.
-
FIG. 1 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention, in a collapsed position; -
FIG. 2 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention, in a partially expanded position; -
FIG. 3 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention, in a partially expanded position; -
FIG. 4 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention, in a fully expanded position; -
FIG. 5 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention, in a fully expanded position; -
FIG. 6 is an exploded parts view of a geared cam expandable spinal implant in accordance with the invention; -
FIG. 7 is an upper perspective view of a lower endplate, chassis portion, yoke, rotating portion, and spur gears, of a geared cam expandable spinal implant in accordance with the invention; -
FIG. 8 is a cross-sectional side view of a geared cam expandable spinal implant in accordance with the invention, in a collapsed position; -
FIG. 9 is a cross-sectional side view of a geared cam expandable spinal implant in accordance with the invention, in a fully-expanded position; -
FIGS. 10-16 are side schematic views of a multi-stage expansion mechanism used in one preferred embodiment of a geared cam expandable spinal implant in accordance with the invention; -
FIG. 17 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention, in a collapsed position; -
FIG. 18 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention, in a fully open position; -
FIG. 19 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention, in a partially expanded position; -
FIG. 20 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention, in a fully expanded position; -
FIG. 21 is a side cross-sectional view of a geared cam expandable spinal implant in accordance with the invention, in a partially expanded position; -
FIG. 22 is a side cross-sectional view of a geared cam expandable spinal implant in accordance with the invention, in a fully expanded position; -
FIG. 23 is an upper perspective view of another embodiment of a geared cam expandable spinal implant in accordance with the invention, in a collapsed position; -
FIG. 24 is an upper perspective view of the embodiment ofFIG. 23 , in a fully expanded position; -
FIG. 25 is an exploded parts view of a geared cam expandable implant in accordance with the invention; -
FIG. 26 is a side cross-sectional view of a geared cam expandable spinal implant in accordance with the invention, in a collapsed position; -
FIG. 27 is a side cross-sectional view of a geared cam expandable spinal implant in accordance with the invention in a fully expanded position; -
FIGS. 28 and 29 are rear views of a geared cam expandable spinal implant in accordance with the invention; -
FIG. 30 is a side cross-sectional view of a geared cam expandable spinal implant in accordance with the invention in a collapsed position; -
FIG. 31 is a side cross-sectional view of a geared cam expandable spinal implant in accordance with the invention in a fully expanded position; -
FIGS. 32-34 are side schematic views of a spur gear and rack in a one-stage expansion mechanism; -
FIG. 35 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention in a collapsed position; -
FIG. 36 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention in a fully expanded position; -
FIG. 37 is an upper perspective view of a geared cam expandable spinal implant in accordance with the invention in a fully expanded position; -
FIG. 38 is an upper perspective cross-sectional view of an implant insertion tool in accordance with the invention connected to a geared cam expandable spinal implant in accordance with the invention; -
FIG. 39 is an upper perspective view of an implant insertion tool in accordance with the invention connected to a geared cam expandable spinal implant in accordance with the invention, depicting insertion of the implant into a disc space; -
FIG. 40 is an upper perspective cross-sectional view of an implant insertion tool in accordance with the invention connected to a geared cam expandable spinal implant in accordance with the invention; -
FIG. 41 is an upper perspective cross-sectional view of a geared cam expandable implant attached to an implant insertion tool in accordance with the invention; -
FIG. 42 is an upper perspective cross sectional view of a geared cam expandable implant in accordance with the invention being inserted into a disc space by an implant insertion tool in accordance with the invention; -
FIG. 43 is an upper perspective cross sectional view of a geared cam expandable implant in accordance with the invention being inserted into a disc space by an implant insertion tool in accordance with the invention; -
FIG. 44 is an upper perspective cross sectional view of a geared cam expandable implant inserted into the disc space, following removal of the implant insertion tool; -
FIG. 45 is an upper perspective view of a geared cam expandable implant in accordance with the invention being supported by a lower vertebral body; -
FIG. 46 is an upper perspective view depicting points of attachment between a geared cam expandable implant in accordance with the invention, and an implant insertion tool in accordance with the invention. -
FIG. 47 is a side cross-sectional view of a geared cam expandable spinal implant in accordance with the invention; -
FIG. 48 is a side cross-sectional view of a geared cam expandable spinal implant in accordance with the invention; -
FIG. 49 is a partial upper perspective view depicting a lower endplate, chassis, yoke, lower spur gear, and cylinder with circumferential ratchet teeth; -
FIG. 50 is a perspective view of a geared cam expandable implant in accordance with the invention, including deployable spikes, pivotally attached to the implant, in a fully-expanded position; -
FIG. 51 is a perspective view depicting a chassis portion, a yoke, a rotating portion, spur gears, and deployable spikes pivotally attached to the yoke, of a geared cam expandable implant in accordance with the invention; -
FIG. 52 is a side view of a geared cam expandable implant in accordance with the invention, including deployable spikes, pivotally attached to the implant, in a collapsed position; -
FIG. 53 is a side view of a geared cam expandable implant in accordance with the invention, including deployable spikes, pivotally attached to the implant in a partially expanded position; -
FIG. 54 is a side view of a geared cam expandable implant in accordance with the invention, including deployable spikes, pivotally attached to the implant, in a fully expanded position; -
FIG. 55 is a side view of a geared cam expandable implant in accordance with the invention, including deployable spikes, pivotally attached to the implant, and including apertures defined through internal parts, in a fully expanded position; -
FIG. 56 is a side view of a geared cam expandable implant in accordance with the invention, in a collapsed position, including deployable spikes, pivotally attached to the implant, and including lateral openings to allow flow of bone graft material out of sides of the implant, and further including a planar portion in the upper endplate to distribute load forces, in a fully expanded position; -
FIG. 57 is a front view of a geared cam expandable implant in accordance with the invention, including flaps attached to sides of the implant, in a closed position; -
FIG. 58 is an upper view of a geared cam expandable implant in accordance with the invention, including flaps attached to sides of the implant, in a closed position; -
FIG. 59 is a side view of a geared cam expandable implant in accordance with the invention, including flaps attached to sides of the implant, in a closed position; -
FIG. 60 is a side cross-sectional view of a geared cam expandable implant in accordance with the invention, in a collapsed position, with a bone graft insertion apparatus connected to a proximal end of the implant; -
FIG. 61 is a side cross-sectional view of a geared cam expandable implant in accordance with the invention, in a fully expanded position, with a bone graft insertion apparatus connected to a proximal end of the implant; and -
FIG. 62 is a side cross-sectional view of a geared cam expandable implant in accordance with the invention, in a fully expanded position, with a bone graft insertion apparatus connected to a proximal end of the implant, and a graft insertion tube filled with bone graft material provided within the bone graft insertion apparatus. - A geared cam expandable
spinal implant 10 is configured to be inserted in a surgically-enhanced disc space between an upper vertebral body and an adjacent lower vertebral body. Theimplant 10 includes aproximal end 12 and adistal end 14, defining a mid-longitudinal axis L-L therebetween. - In one embodiment, the
implant 10 includes anupper endplate 16. As depicted inFIGS. 6, 8, and 9 , theupper endplate 16 includes aproximal end 18, adistal end 20, side surfaces 22, and an inner surface 24. The inner surface 24 includes anupper rack portion 26, which includes downwardly-projectingteeth 28, and a distal-most downwardly-projectingtooth 29. - In one embodiment, the
implant 10 includes alower endplate 30. Thelower endplate 30 includes aproximal end 32, adistal end 34, side surfaces 36, and aninner surface 38. Theinner surface 38 includes alower rack portion 40, which includes upwardly-projectingteeth 42, and a distal-most upwardly-projectingtooth 43. - In one embodiment, the
implant 10 includes achassis portion 44 mounted within the implant between theupper endplate 16 and thelower endplate 30. Thechassis portion 44 includes aproximal end 46 and adistal end 48. As depicted inFIGS. 7-9, 21, 22, and 46 , theproximal end 46 of thechassis portion 44 is a wall perpendicular to the mid-longitudinal axis L-L, having anopening 50 defined through the wall, and one ormore depressions 52 defined in the wall proximate theopening 50. Thechassis portion 44 further includes a first set ofinternal threads 54 defined in theopening 50 of theproximal end 46. - In one embodiment, as depicted in
FIGS. 1-7 , thechassis portion 44 includes anarcuate portion 56 intermediate theproximal end 46 and thedistal end 48. A second set ofinternal threads 58 is defined on an inner surface of thearcuate portion 56. - In one embodiment, a
yoke 60 is movably mounted within thechassis portion 44. Theyoke 60 is defined by afirst wall 62, and a parallelsecond wall 64 spaced away from thefirst wall 62.First wall 62 has aproximal end 66 and adistal end 68.Second wall 64 has aproximal end 70 and adistal end 72. As depicted inFIGS. 6, 7, and 41-43 , distal ends 68 and 72 of first andsecond walls distal end cross-piece 71. As depicted inFIG. 5 , theyoke 60 includes aslot 74 defined in at least one offirst wall 62 andsecond wall 64. Eachslot 74 is configured to receive therein apin 76 projecting from an inner side surface of thelower endplate 30. Insertion of thepin 76 into theslot 74 assists in preventing separation of theimplant 10. - In one embodiment, a rotating
portion 78 is rotatably mounted within thechassis portion 44. Rotatingportion 78 includes aproximal end 80, a distal end 82, and anouter surface 84, withouter threads 86 defined on theouter surface 84. In one embodiment, as depicted inFIGS. 6, 8, 9, 20-22, 25-27, 30, and 31 , the distal end 82 includes a T-shapedprojection 88. The invention, however, is not limited to having a T-shaped projection at the distal end 82 of the rotatingportion 78. In one embodiment, theproximal end 80 of the rotating portion includes anopening 89, configured to receive therein a distal end of an implant expansion tool (not shown). The invention is not limited to any particular configuration for theopening 89, as long as the rotatingportion 78 can be rotated by the implant expansion tool. As depicted inFIGS. 8 and 9 , theopening 89 has a polygonal shape to receive a polygonal-shaped distal end of the implant expansion tool. As another example, but not by way of limitation, theopening 89 could be threaded to receive a threaded distal end of the implant expansion tool. - In one embodiment, as depicted in
FIG. 47-49 , the threaded rotatingportion 78 has been replaced by acylinder 164 withcircumferential ratchet teeth 166, and themating threads 54 on thearcuate portion 56 have been replaced byintegral pawls 168. Theratchet teeth 166 are separated bygrooves 170. Thepawls 168 are allowed to flex because they are integral with “live” springs 172 attached to thechassis portion 44. In this embodiment, as theribbed cylinder 164 is advanced, eachpawl 168 advances to the nextrespective groove 170. In this manner, the distal end of thecylinder 164 pushes on theyoke 60, causing the spur gears 90 and 94 to walk toward thedistal end 14 of theimplant 10, expanding the implant, while thepawls 168 are retained in therespective grooves 170 between theratchet teeth 166, thereby retaining theimplant 10 in its current expanded position. - In one embodiment, a pair of first spur gears 90 is rotatably mounted to the
distal end 68 of thefirst wall 62 of theyoke 60, and thedistal end 72 of thesecond wall 64 of theyoke 60, respectively. Eachfirst spur gear 90 includes projecting firstspur gear teeth 92, configured to engage with the downwardly-projectingteeth 28 of theupper rack portion 26. - In one embodiment, as depicted in
FIGS. 5-7, 18, 24, 36, and 37 , asecond spur gear 94 is rotatably mounted between thedistal end 68 of thefirst wall 62 of theyoke 60, and thedistal end 72 of thesecond wall 64 of theyoke 60, respectively. As depicted inFIG. 6 , the spur gears 90 and 94 are rotatably attached to theyoke 60 with apin 98. Thesecond spur gear 94 includes projecting secondspur gear teeth 96, configured to engage with the upwardly-projectingteeth 42 of thelower rack portion 40. The invention is not limited to having two first spur gears 90 and onesecond spur gear 94. For example, as depicted inFIG. 20 , the invention can include two first spur gears 90 and two second spur gears 94. It is also within the scope of the invention to have onefirst spur gear 90, and two second spur gears 94. - In one embodiment, as depicted in
FIGS. 19 and 20 , aslot 160 is defined in theside surface 36 proximate thedistal end 34 of thelower endplate 30, and apin 162 is defined projecting from asecond spur gear 94.Pin 162 is configured to engage withslot 160, to help prevent the upper and lower endplates from separating. - In one embodiment, the rotating
portion 78 rotates within thechassis portion 44, with theouter threads 86 of the rotatingportion 78 engaging threadedportion 58 of thechassis portion 44, until the distal end 82 of the rotatingportion 78 contacts thedistal cross-piece 71 of theyoke 60. Rotation of the rotatingportion 78 is translated into linear motion of theyoke 60 towards thedistal end 14 of theimplant 10. Linear motion of theyoke 60 causes the first spur gears 90, and the second spur gears 94 to rotate. The respective firstspur gear teeth 92 and secondspur gear teeth 96 “walk” towards thedistal end 14 of theimplant 10 in the respective downwardly-projectingteeth 28 of theupper rack portion 26, and upwardly-projectingteeth 42 of thelower rack portion 40. As the teeth “walk,” theupper endplate 16 is moved away from thelower endplate 30, thereby moving theimplant 10 into and through the partially-expanded position. When the respectivespur gear teeth tooth 29, or alternately the distal-most upwardly-projectingtooth 43, they can “walk” no farther towards the distal end of theimplant 10, and the implant has reached the fully-expanded position. The amount of expansion in the fully-expanded position is related to the length of the spur gears. As depicted inFIG. 6 , the spur gears have a length S1, but different spur gear lengths are possible, depending on the requirements of an individual patient. Different amounts of full expansion, related to spur gear length are depicted, for example, inFIGS. 4, 5, 9, 20 , and 22. - In one embodiment, as depicted in
FIGS. 32-34 , the spur gears 90 and 94 “walk” along therespective racks - In one embodiment, as depicted in
FIGS. 10-16 , the spur gears 90 and 94 “walk” along therespective racks FIGS. 10 and 11 , and subsequently pivoting in a ball and socket fashion, as depicted inFIGS. 12 and 13 . As depicted inFIGS. 14-16 , the circumferences of the pitch diameters translate along each other as the gear is advanced. This translation allows a higher angle of incidence at the starting point for the device as compared to a fixed-length link mechanism. The angle of incidence/mechanical advantage starts high and decreases as the gear is advanced, increasing as the gear advances further. The multi-stage expansion pattern allows a constant angle of attack of the gear with the rack. - In one embodiment, as depicted in
FIGS. 1 and 2 , theupper endplate 16 includesprojections 100, configured to engage a surface of the endplate of the upper vertebral body (not shown). Theupper endplate 16 further includes anopening 102 defined therein, configured to allow bone growth from bone growth material loaded in theimplant 10 to pass through theopening 102 and fuse with the upper vertebral body. Theupper endplate 16 further includes asmooth surface 104, configured to distribute the vertebral body endplate loading. Thesmooth surfaces 104 can be configured along a majority of the length of the upper surface of theupper endplate 16, as depicted inFIGS. 1 and 2 , or for only a portion of the length of the upper surface, to contact only the softer cancellous-like bone off the upper vertebral body endplate. - In one embodiment, as depicted in
FIGS. 8 and 9 , thelower endplate 30 includesprojections 106 for engaging the endplate of the lower vertebral body (depicted inFIG. 45 ), and anopening 108 configured to allow bone growth from the bone graft material in theimplant 10 to pass through theopening 108 and fuse with the lower vertebral body. - In one embodiment, the
distal end 20 of theupper endplate 16, and thedistal end 34 of thelower endplate 30 define atip 110. Thetip 110 can be beveled, as depicted inFIG. 45 ; flat, as depicted inFIGS. 23 and 24 ; or come to a central point, as depicted inFIG. 26 . - In one embodiment, the
tip 110 can include bone-engagingprojections 112. In accordance with another embodiment, thetip 110 can have no projections. The bone-engagingprojections 112 are configured to prevent implant migration as theimplant 10 is expanding. The bone-engagingprojections 112 may be perpendicular to the side surfaces 22 and 36, but generally follow the shape of thetip 110, or they could be parallel to thetip 110. - In one embodiment as depicted in
FIGS. 35 and 36 , an engagingpin 114 extends from at least onespur gear slot 116 in a side of theupper endplate 16. Engagement of theengaging pin 114 inslot 116 assists in preventing theendplates implant 10. - In one embodiment, as depicted in
FIGS. 35 and 36 , anupper gear 118 is defined at theproximal end 18 of theupper endplate 16, in engagement with alower gear 120 defined at theproximal end 32 of thelower endplate 30. Engagement of the upper and lowerproximal gears endplates implant 10. - In one embodiment, an independent proximal expansion mechanism 122 is defined at the
proximal end 12 of theimplant 10. As depicted inFIGS. 28-31, 35, and 36 , the proximal expansion mechanism 122 includes a proximal-end polygonal-shapedtoggle 124, attached to theproximal end 80 of the rotatingportion 78. A pair of proximal-end pivot pins 126 projects from the proximal-end toggle 124. In one embodiment, thetoggle 124 can have one distraction position while in another embodiment, thetoggle 124 can have progressive distraction positions. In one embodiment, thetoggle 124 can be rotated, while in another embodiment, thetoggle 124 can be translated. In the embodiment where thetoggle 124 is rotated, the pivot pins 126 distract, using a cam-like action. In the embodiment where thetoggle 124 is translated, the pivot pins 126 are distracted by sliding alongproximal ramps 128. - In one embodiment, an
insertion tool 130, depicted inFIGS. 38-44 and 46 , includes aproximal end 132, and adistal end 134. An outer hollowcylindrical shaft 136 extends between theproximal end 132 and thedistal end 134. An inner hollowcylindrical shaft 138 extends through theouter shaft 136. Theinner shaft 138 has aproximal end 140 and adistal end 142. - In one embodiment, as depicted in
FIG. 38 , a T-handle 158 is defined at theproximal end 140 of theinner shaft 138. The T-handle 158 attaches to anelongated driver 143, which extends through theinner shaft 138. - In one embodiment, as depicted in
FIGS. 42 and 43 , theelongated driver 143 has a bluntdistal end 154. - In one embodiment, as depicted in
FIG. 39 , atap cap 144 is defined at theproximal end 140 of theinner shaft 138, attached to thedriver 143. - In one embodiment, as depicted in
FIG. 40 , thetap cap 144 fits removably into afunnel 146 defined at theproximal end 140 of theinner shaft 138. - In one embodiment, a
handle 148 is provided, gripping an outer surface of theouter shaft 136. Handle 148 is configured to be held by a surgeon while using theinsertion tool 130. - In one embodiment, as depicted in
FIG. 46 , thedistal end 134 of theouter shaft 136 includes projectingfingers 150, configured to fit into thedepressions 52, proximate theopening 50 in theproximal end 46 of thechassis portion 44. - In one embodiment, as depicted in
FIGS. 40 and 46 , thedistal end 142 of theinner shaft 138 includesexternal threads 152, configured to engage the first set ofinner threads 54 in theopening 50 of thechassis portion 44. - In one embodiment, as depicted in
FIGS. 38, 39, and 42 , moving theelongated driver 143, either by applying a force to the T-handle 158, or by applying a force to thetap cap 144, theelongated driver 143 is moved through theinner shaft 138, through theopening 50 in theproximal end 46 of thechassis portion 44, and through thechassis portion 44, until the blunt proximal end opening 89 in the rotatingportion 78. Translation of the motion of theelongated driver 143 to the rotatingportion 78 pushes theimplant 10 into the disc space. Following removal of theelongated driver 143 from theimplant 10 and theinner shaft 138, as depicted inFIG. 44 , bone growth material can be inserted through theinner shaft 138 and into theimplant 10. - In one embodiment, as depicted in
FIGS. 50-54 ,upper spikes 174 andlower spikes 176 are pivotally connected to thewalls yoke 60. Eachupper spike 174 includes aproximal end 177 pivotally connected to a wall of the yoke, and adistal end 178. Eachlower spike 176 includes aproximal end 180 pivotally connected to a wall of the yoke, and adistal end 182. Eachdistal end 178 includes an upper arcuatedistal end portion 184 and anupper edge 185. Eachdistal end 182 includes a lower arcuatedistal end portion 186 and a lowerdistal edge 188. - In one embodiment, as depicted in
FIG. 52 ,upper pockets 190 are defined within theimplant 10 to store theupper spikes 174 when theimplant 10 is in the collapsed position. Likewise,lower pockets 192 are defined within theimplant 10 to store thelower spikes 176 when theimplant 10 is in the collapsed position. - In one embodiment, as depicted in
FIGS. 50, 52 and 53 , anupper opening 194 is defined in theupper endplate 16 proximate theupper pocket 190. Alower opening 196 is defined in thelower endplate 30 proximate thelower pocket 192. Theupper opening 194 includes an upper rampedsurface 198 at a distal end thereof, and thelower opening 196 includes a lower rampedsurface 200 at a distal end thereof. When theyoke 60 begins to move in the distal direction, and theimplant 10 begins to expand, theupper spikes 174 and thelower spikes 176 are simultaneously pushed by theyoke 60 in the distal direction. Upper arcuatedistal end portions 184 of theupper spikes 174 are pushed into contact with the upper rampedsurface 198 of theupper opening 194 in theupper endplate 16, and lower arcuatedistal end portions 186 of thelower spikes 176 are pushed into contact with the lower rampedsurface 200 of thelower opening 196 of thelower endplate 30. The distal force applied by theyoke 60, pushing the upper arcuatedistal end portions 184 of theupper spikes 174 into contact with the upper rampedsurface 198 defined in the distal end of theupper opening 194 defines a torque T (upper). Torque T (upper) forces theupper spikes 174 to pivot clockwise, through theupper opening 194. Likewise, the distal force applied by theyoke 60, pushing the arcuatedistal end portions 186 of thelower spikes 176 into contact with the lower rampedsurface 200 of thelower opening 196 defines a torque T (lower). Torque T (lower) forces thelower spikes 176 to pivot counter-clockwise, through thelower opening 196 in thelower endplate 30. As theimplant 10 continues to expand, theupper spikes 174 continue to pivot until they reach an orientation along an axis which is transverse to the mid-longitudinal axis L-L of theimplant 10, with theupper edges 185 engaging the upper vertebral body. Likewise, thelower spikes 176 continue to pivot until they reach an orientation along an axis transverse to the mid-longitudinal axis L-L of theimplant 10, with thelower edges 188 engaging the lower vertebral body. - In one embodiment, as depicted in
FIG. 55 , apertures can be defined in internal parts of the implant, for exampleco-axial apertures 202 andtransverse apertures 204 defined in the rotatingportion 78. Theapertures proximal end 46 of thechassis 44. - In one embodiment, as depicted in
FIG. 55 , as theyoke 60 moves in the distal direction, deploying the upper andlower spikes co-axial aperture 206 is opened in thechassis 44 behind the proximal ends 177 and 180 of thespikes Co-axial aperture 206 also is configured to allow a flow of bone growth material therethrough. - In one embodiment, as depicted in
FIG. 57 , flaps 208 are attached to the right and left sides of the implant 10 (only one side shown), with upper and lower edges thereof connected between theupper endplate 16 and thelower endplate 30. Theflaps 208 can be made of a porous material, a semi-porous material, or a solid material. When theimplant 10 is expanded, as depicted inFIG. 57 , theflaps 208 are deployed, stretched tightly between theupper endplate 16 and thelower endplate 30. - In one embodiment, as depicted in
FIGS. 60-62 , animplant 10 includes abone graft inserter 210, attachable to attachment clamps 212 provided at theproximal end 46 of thechassis portion 44. The bone graft inserter includes anouter tube 214 defining alumen 216 therethrough, and ahandle 218. The attachment clamps 212 are positioned to firmly grip a distal end of theouter tube 214. - In one embodiment, as depicted in
FIGS. 60-62 , agraft tube 220 is provided within thelumen 216. Bone graft material in thegraft tube 220 is in position to flow into thechassis portion 44 of theimplant 10 via the connection between the attachment clamps 212 and theouter tube 214. As further depicted inFIGS. 60-62 , the bone graft material inserted into thechassis portion 44 of theimplant 10 can flow out of theimplant 10 via multiple small apertures (not shown) in the upper andlower endplates implant 10. - In one embodiment, as depicted in
FIGS. 58 and 59 , arigid plunger 222 is provided in thelumen 216. Theplunger 222 includes ahead portion 224 at a distal end thereof. Thehead portion 224 has a diameter approximately equal to a diameter of thelumen 216. When theplunger 222 slides within thelumen 216 in the distal direction, thehead portion 224 pushes bone graft material in the distal direction and into theproximal end 46 of thechassis portion 44. - Other embodiments of the invention will be apparent to those skilled in the art from consideration of the specification and practice of the invention disclosed herein. It is intended that the specification and examples be considered as exemplary only, with a true scope and spirit of the invention being indicated by the following claims.
Claims (21)
1. An expandable spinal implant for insertion into a patient's disc space between an upper vertebral body and a lower vertebral body, the implant having a proximal end and a distal end defining a mid-longitudinal axis therebetween, and being expandable between a collapsed position, a partially-expanded position, and a fully-expanded position, the implant comprising:
an upper endplate, the upper endplate including a proximal end, a distal end, an outer surface, at least one side surface, and an inner surface, a portion of the inner surface including an upper rack portion, the upper rack portion including at least one downwardly-projecting tooth intermediate the proximal end and the distal end of the upper endplate, and at least one distal-most downwardly-projecting tooth proximate the distal end of the upper endplate;
a lower endplate, the lower endplate including a proximal end, a distal end, an outer surface, at least one side surface, and an inner surface, a portion of the inner surface including a lower rack portion, the lower rack portion including at least one upwardly-projecting tooth intermediate the proximal end and the distal end of the lower endplate, and at least one distal-most upwardly-projecting tooth proximate the distal end of the lower endplate, the proximal end of the lower endplate being pivotally connected to the proximal end of the upper endplate;
a chassis portion mounted within the implant between the upper endplate and the lower endplate, the chassis portion having a proximal end and a distal end, the proximal end having an opening defined therein, at least one depression defined therein proximate the opening, a first set of inner threads defined in the opening, and a second set of inner threads defined intermediate the proximal end and the distal end of the chassis portion;
a yoke movably mounted within the chassis portion the yoke having a proximal end and a distal end, and being defined by first and second substantially parallel spaced apart walls, each of the first and second spaced apart walls having a proximal end and a distal end;
a rotating portion rotatably mounted within the chassis portion, the rotating portion having an outer surface, a proximal end and a distal end, the proximal end having an opening defined therein, the distal end being positioned proximate the distal end of the yoke, and threads defined on at least a portion of the outer surface, the threads being engageable with the second set of inner threads in the chassis portion;
at least one first spur gear rotatably mounted to at least one of the distal ends of at least one of the first and second spaced apart walls of the yoke, the at least one first spur gear having at least one projecting first spur gear tooth configured to movably engage with the downwardly-depending teeth on the upper rack portion;
at least one second spur gear rotatably mounted to at least one of the distal ends of at least one of the first and second spaced apart walls of the yoke, the at least one second spur gear having at least one projecting second spur gear tooth configured to engage with the upwardly-projecting teeth on the lower rack portion; and
at least one spike pivotally attached to at least one of the first and second spaced apart walls of the yoke;
wherein the rotating portion is further configured to translate rotational motion thereof to linear motion of the yoke, the yoke translating the linear motion to rotational motion of at least the at least one first spur gear, thereby rotating the at least one first spur gear with respect to the yoke;
wherein the rotation of the at least one first spur gear with respect to the yoke defines a first linear walking motion of the at least one projecting first spur gear tooth along the downwardly-depending upper rack gear teeth toward the distal end of the implant, thereby pivoting the upper endplate to at least the partially-expanded position; and
wherein the linear motion of the yoke is translated to pivotal motion of the at least one spike from a collapsed position, to a fully-deployed position transverse to the mid-longitudinal axis.
2. The expandable spinal implant of claim 1 , wherein at least one of the upper endplate and the lower endplate includes at least one projection projecting from the outer surface thereof, the at least one projection configured to engage a corresponding endplate of the respective upper vertebral body and lower vertebral body.
3. The expandable spinal implant of claim 1 , wherein the yoke further includes at least one side surface, the at least one side surface having a track defined therein, the track being configured to receive therein a peg projecting from the at least one side surface of one of the lower endplate and the upper endplate, thereby preventing disengagement of the upper endplate from the lower endplate.
4. The expandable spinal implant of claim 1 , wherein the rotation of the rotating portion further translates motion to at least the at least one second spur gear to rotate the at least one second spur gear with respect to the yoke, the rotation of the at least one second spur gear with respect to the yoke defining a second linear walking motion of the at least one projecting second spur gear tooth along the upwardly-projecting lower rack gear teeth toward the distal end of the implant, pivoting the lower endplate at least to the partially-expanded position.
5. The expandable spinal implant of claim 1 , further comprising at least one pocket defined between the upper endplate and the lower endplate configured to house the at least one spike when the implant is in the collapsed position.
6. The expandable spinal implant of claim 1 , wherein the pivotal motion of the at least one spike to the fully-deployed position exposes at least one window defined in at least the chassis portion.
7. The expandable spinal implant of claim 6 , wherein the at least one window defined in at least the chassis portion is configured to allow flow of bone graft material therethrough.
8. The expandable spinal implant of claim 1 , wherein the rotating portion is generally cylindrical, and includes a set of external threads defined on an outer peripheral surface thereof.
9. The expandable spinal implant of claim 8 , wherein the rotating portion includes at least one aperture defined in the outer peripheral surface, the at least one aperture being configured to allow flow of bone graft material therethrough.
10. The expandable spinal implant of claim 1 , wherein the at least one spike pivotally attached to the one of the first and second spaced apart walls of the yoke further comprises at least two spikes pivotally attached to the one of the first and second spaced apart walls of the yoke.
11. The expandable implant of claim 1 , wherein the at least one spike pivotally attached to the one of the first and second spaced apart walls of the yoke further comprises a first pair of spikes pivotally attached to the first wall of the yoke, and a second pair of spikes pivotally attached to the second wall of the yoke.
12. The expandable spinal implant of claim 1 , further comprising an upper gear mounted proximate the proximal portion of the upper endplate, and a lower gear mounted proximate the proximal portion of the lower endplate, the lower gear pivotally engaging the upper gear, the engagement of the upper gear and the lower gear preventing disengagement of the upper endplate from the lower endplate.
13. The expandable spinal implant of claim 1 , wherein at least the upper rack portion includes a distal-most downwardly-depending upper rack gear tooth, configured to stop at least the walking motion of the at least one first spur gear along the downwardly depending upper rack gear teeth toward the distal end of the implant, thereby moving the upper endplate away from the lower endplate toward the fully expanded position.
14. The expandable spinal implant of claim 1 , wherein at least the lower rack portion includes a distal-most upwardly-projecting lower rack gear tooth, configured to stop at least the walking motion of the at least one second spur gear along the upwardly-projecting lower rack gear teeth toward the distal end of the implant, thereby moving the upper endplate away from the lower endplate toward the fully expanded position.
15. The expandable spinal implant of claim 1 , further comprising at least one opening defined in at least one of the upper endplate and the lower endplate, the at least one opening being configured for the at least one spike to pass therethrough when the at least one spike pivots to the fully-deployed position.
16. The expandable spinal implant of claim 15 , wherein the at least one opening includes a proximal end, a distal end, and a ramped portion defined at the distal end, the ramped portion being positioned to contact an arcuate portion defined on a distal end of the at least one spike, wherein the contact between the ramped portion and the arcuate portion defines a torque, the torque pivoting the at least one spike to the fully-deployed position.
17. The expandable spinal implant of claim 1 , wherein a distal edge portion of the at least one spike, in the fully-deployed position, is configured to contact at least one of the upper vertebral body and the lower vertebral body and prevent inadvertent backout of the implant from the disc space.
18. A kit for inserting an expandable spinal implant into a patient's disc space between an upper vertebral body and a lower vertebral body, the kit comprising:
the implant, the implant comprising:
an upper endplate, the upper endplate including a proximal end, a distal end, an outer surface, at least one side surface, and an inner surface, a portion of the inner surface including an upper rack portion, the upper rack portion including at least one downwardly-projecting tooth intermediate the proximal end and the distal end of the upper endplate, and at least one distal-most downwardly-projecting tooth proximate the distal end of the upper endplate;
a lower endplate, the lower endplate including a proximal end, a distal end, an outer surface, at least one side surface, and an inner surface, a portion of the inner surface including a lower rack portion, the lower rack portion including at least one upwardly-projecting tooth intermediate the proximal end and the distal end of the lower endplate, and at least one distal-most upwardly-projecting tooth proximate the distal end of the lower endplate, the proximal end of the lower endplate being pivotally connected to the proximal end of the upper endplate;
a chassis portion mounted within the implant between the upper endplate and the lower endplate, the chassis portion having a proximal end and a distal end, the proximal end having an opening defined therein, at least one depression defined therein proximate the opening, a first set of inner threads defined in the opening, and a second set of inner threads defined intermediate the proximal end and the distal end of the chassis portion;
a yoke movably mounted within the chassis portion, the yoke having a proximal end and a distal end, and being defined by first and second substantially parallel spaced apart walls, each of the first and second spaced apart walls having a proximal end and a distal end;
a rotating portion rotatably mounted within the chassis portion, the rotating portion having an outer surface, a proximal end, and a distal end, the proximal end having an opening defined therein, the distal end being positioned proximate the distal end of the yoke, and threads defined on at least a portion of the outer surface, the threads being engageable with the second set of inner threads in the chassis portion;
at least one first spur gear rotatably mounted to at least one of the distal ends of at least one of the first and second spaced apart walls of the yoke, the at least one first spur gear having at least one projecting first spur gear tooth configured to movably engage with the downwardly-depending teeth on the upper rack portion;
at least one second spur gear rotatably mounted to at least one of the distal ends of at least one of the first and second spaced apart walls of the yoke, the at least one second spur gear having at least one projecting second spur gear tooth configured to engage with the upwardly-projecting teeth on the lower rack portion; and
at least one spike pivotally attached to one of the first and second spaced apart walls of the yoke;
wherein the rotating portion is further configured to translate rotational motion thereof to linear motion of the yoke, the yoke translating the linear motion to rotational motion of at least the at least one first spur gear, thereby rotating the at least one first spur gear with respect to the yoke;
wherein the rotation of at least the at least one first spur gear with respect to the yoke defines a first linear walking motion of the at least one projecting first spur gear tooth along the downwardly-depending upper rack gear teeth toward the distal end of the implant, thereby pivoting the upper endplate to at least the partially-expanded position; and
wherein the linear motion of the yoke translates to pivotal motion of the at least one spike, from a collapsed position to a fully-deployed position transverse to the mid-longitudinal axis; and
an insertion tool attachable to the proximal end of the implant.
19. A method of implanting an expandable spinal implant into a patient's disc space between an upper vertebral body and a lower vertebral body, the method comprising:
utilizing the expandable spinal implant, the implant having a proximal end and a distal end defining a mid-longitudinal axis therebetween, and being expandable between a collapsed position, a partially-expanded position, and a fully-expanded position, the implant comprising:
an upper endplate, the upper endplate including a proximal end, a distal end, an outer surface, at least one side surface, and an inner surface, a portion of the inner surface including an upper rack portion, the upper rack portion including at least one downwardly-projecting tooth intermediate the proximal end and the distal end of the upper endplate, and at least one distal-most downwardly-projecting tooth proximate the distal end of the upper endplate;
a lower endplate, the lower endplate including a proximal end, a distal end, an outer surface, at least one side surface, and an inner surface, a portion of the inner surface including a lower rack portion, the lower rack portion including at least one upwardly-projecting tooth intermediate the proximal end and the distal end of the lower endplate, and at least one distal-most upwardly-projecting tooth proximate the distal end of the lower endplate, the proximal end of the lower endplate being pivotally connected to the proximal end of the upper endplate;
a chassis portion mounted within the implant between the upper endplate and the lower endplate, the chassis portion having a proximal end and a distal end, the proximal end having an opening defined therein, at least one depression defined therein proximate the opening, a first set of threads defined in the opening, and a second set of inner threads defined intermediate the proximal end and the distal end of the chassis portion;
a yoke movably mounted within the chassis portion, the yoke having a proximal end and a distal end, and being defined by first and second substantially parallel spaced apart walls, each of the first and second spaced apart walls having a proximal end and a distal end;
a rotating portion rotatably mounted within the yoke, the rotating portion having an outer surface, a proximal end and a distal end, the proximal end having an opening defined therein, the distal end being positioned proximate the distal end of the yoke, and threads defined on at least a portion of the outer surface, the threads being engageable with the second set of inner threads on the chassis portion;
at least one first spur gear rotatably mounted to at least one of the distal ends of at least one of the first and second spaced apart walls of the yoke, the at least one first spur gear having at least one projecting first spur gear tooth configured to movably engage with the downwardly-projecting rack teeth on the upper rack portion;
at least one second spur gear rotatably mounted to at least one of the distal ends of at least one of the first and second spaced apart walls of the yoke, the at least one second spur gear having at least one projecting second spur gear tooth configured to engage with the upwardly-projecting teeth on the lower rack portion; and
at least one spike pivotally attached to at least one of the first and second spaced apart walls of the yoke;
wherein the rotating portion is further configured to translate rotational motion thereof to linear motion of the yoke, the yoke translating the linear motion to rotational motion of at least the at least one first spur gear, thereby rotating the at least one first spur gear with respect to the yoke;
wherein the rotation of the at least one first spur gear with respect to the yoke defines a first linear walking motion of the at least one projecting first spur gear tooth along the downwardly-projecting teeth of the upper rack portion toward the distal end of the implant, thereby pivoting the upper endplate to at least the partially-expanded position; and
wherein the linear motion of the yoke is further translated to pivotal motion of the at least one spike from a collapsed position to a fully-deployed position transverse to the mid-longitudinal axis;
inserting the implant, in the collapsed position, into the disc space between the upper vertebral body, and the lower vertebral body with an insertion tool;
rotating the rotating portion, defining the rotational motion;
translating the rotational motion of the rotating portion into the linear motion of the yoke toward the distal end of the implant;
translating the linear motion of the yoke into rotational motion of at least the at least one first spur gear, and into pivotal motion of the at least one spike;
rotating the at least one first spur gear with respect to the yoke;
walking the at least one first spur gear along the downwardly-projecting teeth of the upper rack portion toward the distal end of the implant;
translating the linear motion of the yoke into the rotational motion of at least the at least one second spur gear;
walking the at least one second spur gear along the upwardly-projecting teeth of the lower rack portion toward the distal end of the implant;
reaching the fully-expanded position when one of the at least one first spur gear contacts the at least one distal-most projecting tooth on the upper rack portion, and the at least one second spur gear contacts the at least one distal-most projecting tooth on the lower rack portion; and
pivoting the at least one spike to the fully-deployed position transverse to the mid-longitudinal axis and into an engagement with at least one of the upper vertebral body and the lower vertebral body.
20. The method of claim 19 , wherein the translating the linear motion of the yoke into pivotal motion of the at least one spike includes forcing an arcuate distal end portion of the at least one spike into contact with a ramped distal end surface of an opening in one of the upper endplate and the lower endplate, the contact between the arcuate distal end portion and the ramped distal end surface defining a torque, the torque pivoting the at least one spike to the fully deployed position.
21. The method of claim 20 , wherein the engagement of the at least one spike with the one of the upper vertebral body and the lower vertebral body prevents the implant, in the fully-expanded position, from inadvertently backing out of the disc space.
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US11135071B2 (en) | 2021-10-05 |
US20190091034A1 (en) | 2019-03-28 |
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